# T W WAGNER INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WAGNER MEDICAL CLINIC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316041957
- **Authorized official:** TOMMY W WAGNER JR. MD (OWNER)
- **Authorized official phone:** (870) 561-3300

## Contact information

- **Practice address:** 331 BROAD STREET, SUITE B, LEPANTO, AR 72354
- **Practice address phone:** (870) 475-3825
- **Practice address fax:** (870) 475-3823
- **Mailing address:** 331 BROAD STREET, SUITE B, LEPANTO, AR 72354
- **Mailing address phone:** (870) 475-3825
- **Mailing address fax:** (870) 475-3823

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 09/12/2006
- **Last updated:** 08/22/2020